Women s Health Initiative

Writing Group for the Women s Health Initiative Investigators (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women principal results from the Women s Health Initiative randomized controlled trial. JAMA 288 321-333... 

CD Since the publication of the Women s Health Initiative study, there has been an increase in the use of non-hormonal therapies for the management of menopausal symptoms. Particularly for women with CHD and breast cancer risk factors, non-hormonal therapies may offer an alternative to assist with symptom management. A wide range of therapies, both prescription and herbal, have been studied with varying degrees of success. In choosing a particular therapy, it is important to match patient symptoms with a therapy that is not only effective but also safe. 

As of 1995, almost 38% of all women 50 to 75 years of age were using HRT.1 It was in 1996 that the United States Preventive Services Task Force (USPSTF) first published its recommendations that not all postmenopausal women should be prescribed HRT, but rather, therapy should be individualized based on risk factors. This recommendation was further supported with publication of the Heart and Estrogen/Progestin Replacement Study (HERS) in 1998, which demonstrated that women who had established CHD were at an increased risk of experiencing a myocardial infarction within the first year of HRT use compared with a similar group of women without CHD risk factors. As a result, the authors concluded that HRT is not recommended for the secondary prevention of CHD.2 Then, in 2002, the Women s Health Initiative (WHI) report was published. This trial demonstrated that HRT was not protective against CHD but... 

WHIMS Women s Health Initiative Memory Study... 

Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy The Women s Health Initiative randomized, controlled trial. JAMA 2004 291 1701-1712. 

Espeland MA, Rapp SR, Shumaker SA, et al. Conjugated equine estrogens and global cognitive function in postmenopausal women Women s Health Initiative memory study. JAMA 2004 291 2959-2968. 

Wassertheil-Smoller S, Hendrix SL, Limacher M, et al. Effect of estrogen plus progestin on stroke in postmenopausal women. The Women s Health Initiative A randomized trial. JAMA 2003 289 2673-2684. 

Mares, J. A., T. L. LaRowe et al. (2006). Predictors of optical density of lutein and zeaxanthin in retinas of older women in the carotenoids in age-related eye disease study, an ancillary study of the women s health initiative. Am. J. Clin. Nutr. 84(5) 1107-1122. 

LaRowe, TL, Mares, JA, Snodderly, DM, Klein, ML, Wooten, BR, and Chappell, R, 2008. Macular pigment density and age-related maculopathy in the Carotenoids in Age-Related Eye Disease Study. An ancillary study of the women s health initiative. Ophthalmology 115, 876-883 e871. 

Moeller, SM, Parekh, N, Tinker, L, Ritenbaugh, C, Blodi, B, Wallace, RB, and Mares, JA, 2006. Associations between intermediate age-related macular degeneration and lutein and zeaxanthin in the Carotenoids in Age-related Eye Disease Study (CAREDS) Ancillary study of the Women s Health Initiative. Arch... 

The continuous combined oral estrogen-progestogen arm of the Women s Health Initiative (WHI) study was terminated prematurely after a mean of 5.2-year follow-up because of the occurrence of a prespecified level of invasive breast cancer. The study also found increased coronary disease events, stroke, and pulmonary embolism. Beneficial effects included decreases in hip fracture and colorectal cancer. 

Finally, a major question in SERM development is whether the new compounds will behave like estrogens with respect to cardiovascular events, which would be a worthless property given the results of the WHI trial (Writing Group for the Women s Health Initiative Investigators 2002 Women s Health Initiative Steering Committee 2004). This is a complex issue that will depend on the unique profile of action of the new SERM on the different components of the atherosclerosis process and the patient population and study design and conduct that is implemented. 

Shumaker SA, Legault C, Kuller L, Rapp SR, Thai L, Lane DS, et al. (2004) Conjugated equibe estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women. Women s Health Initiative Memory Study. J Am Med Assoc 291 2947-2958... 

Speroff L (2002) The impact of the Women s Health Initiative on clinical practice. J Soc Gynecol Invest 9 251-253... 

Hormone therapy has proven highly effective in controlling the menopausal syndrome, especially severe hot flushes (MacLennan et al. 2004), even at doses significantly lower than those used until now (Speroff et al. 2000 Utian et al. 2001). Women s Health Initiative studies found that hormone replacement therapy, when administered as a primary prevention intervention for CVD in older women, increases the risk of heart disease and breast cancer. Even if a protective effect on fracture and colon cancer was observed, the risk-benefit ratio led to a recommendation of this treatment only for the short-term relief of menopausal symptoms (Rossouw et al. 2002 Anderson et al. 2004). The role of early administration of ovarian hormones to young postmenopausal women in the prevention of cardiovascular disease or late dementia remains... 

The results of the WHI (Women s Health Initiative) Estrogen Plus Progesterone clinical trial revealing increased incidence of breast cancer, heart disease, stroke, and dementia are provided in J. E. Rossouw et al., JAMA 288 321-333 (2002). 

Manson JE, Hsia J, Johnson KC, Rossouw JE, Assaf AR, Lasser NL et al. Women s Health Initiative Investigators. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 2003 349 523-34. 

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